House Votes to Expand Children’s Health Care

WASHINGTON — With enthusiastic support from President-elect Barack Obama, the House on Wednesday passed a bill to expand the Children’s Health Insurance Program. President Bush twice had vetoed similar legislation.

Mr. Obama will probably be able to sign the bill within days of taking office on Tuesday. The Senate might take action within a week.

The House vote was 289 to 139. Supporters never mustered more than 273 votes for similar legislation in the last two years.

The bill, which would extend coverage to four million uninsured children, symbolizes the shift in priorities in Washington. The vote came five days after the House, defying a veto threat from Mr. Bush, passed two bills to combat sex discrimination by employers who pay women less than men doing the same or substantially similar work.

The child health bill would provide $32.3 billion over four and a half years to continue coverage for seven million children who now rely on the program and to extend coverage to more than four million who are uninsured.

“This is a day of triumph for America’s children,” Speaker Nancy Pelosi of California said. “We put women and children first.”

After years of frustration, Democrats were exultant.

“Today is a new day,” Representative Dave Loebsack of Iowa. Representative Chris Van Hollen, Democrat of Maryland, said, “Passing this bill sends a very important signal that change has come to Washington as a result of the last election.”

Representative Frank Pallone, Democrat of New Jersey, said the bill was a down payment on Mr. Obama’s promise to make health insurance available to all Americans

“In this moment of crisis, ensuring that every child in America has access to affordable health care is not just good economic policy, but a moral obligation we hold as parents and citizens,” Mr. Obama said in a statement.“That is why I’m so pleased that Democrats and Republicans in the House of Representatives came together to provide health insurance to over ten million children whose families have been hurt most by this downturn. This coverage is critical, it is fully paid for, and I hope that the Senate acts with the same sense of urgency so that it can be one of the first measures I sign into law when I am President.”

The Senate Finance Committee is expected to approve a similar bill on Thursday, with action by the full Senate to follow quickly.

The bills would be financed by an increase in tobacco taxes, including a 61-cent increase in the tax on cigarettes, to $1 pack.

The House bill includes a major new provision that would allow states to restore health insurance benefits to legal immigrants under 21. Under current law, legal immigrants are generally barred from Medicaid and the State Children’s Health Insurance Program for five years after they enter the United States. The House bill would allow states to do away with that waiting period for children and pregnant women.

House Republicans raised several objections to the bill. While the cost of the child health program will increase, they said, tobacco revenues will not, so the government will face a widening gap that will probably be filled with additional tax increases in the future.

Moreover, Republicans said, under the bill, some of the money will be spent to provide public coverage for children who already have private health insurance through their parents’ employers.

Republicans also complained that the bill did not require states to cover the poorest children first, before covering children from middle-income families.

But the difference between the old Congress and the new one was illustrated by the vote of Representative Alan Grayson, Democrat of Florida, who defeated Representative Ric Keller, a Republican, in November.

In explaining why he voted for the bill on Wednesday, Mr. Grayson said: “I was a very sick child. I had to go to the hospital four times a week for treatment. If it weren’t for my parents’ union health benefits, I would not be here today.” By contrast, Mr. Keller voted against nearly identical bills.

Another new House member, Kathy Dahlkemper of Pennsylvania, said she too had been inspired by her own experience.

“One of my goals in running for Congress was to ensure that all eligible kids have health care,” Ms. Dahlkemper said. “I gave birth to one of my children without health insurance due to having a pre-existing condition at the change of a job, and that pre-existing condition was pregnancy.”

Democrats said the recession and rising unemployment had increased the need for the bill. Since the House last voted on the issue in January 2008, the number of unemployed has increased nearly 50 percent, to 11.1 million. People often lose health insurance when they lose their jobs.

“At a time of rising unemployment, this legislation is more important than ever,” said Representative Mike McMahon, a freshman Democrat from New York.